King v CompPartners and the Duty of Care

To what extent are utilization reviewers care providers? That was NOT the central question argued yesterday in the King v CompPartners case before the California Supreme Court. The case appears straightforward; the plaintiff was prescribed Kolonopin, which was denied after going through the UR and IMR process. When he stopped taking the drug, he suffered several grand mal seizures which led to additional injury. The plaintiffs are arguing the UR physician who wrote the final denial should have authorized or otherwise recommended a gradual withdrawal, as seizures are not uncommon when patients suddenly stop taking Klonopin (Mr King had been taking it for two years). In the view of the plaintiffs, failing to do that amounted to medical malpractice . The central legal issue in this case is the exclusive remedy nature of workers’ comp, with the defendant arguing that he cannot be charged with malpractice as the UR determination and related processes took place within the workers’ comp system. While that’s the central issue, it’s not my focus. Rather, I’m interested in the “duty of care” issue. I’ll leave the exclusive remedy issue to the lawyers; the health of the patient – and who is responsible for that – is what’s important to me. There’s some pertinent case law in California that speaks to the “duty of care”, a phrase that infers the physician doing the review is responsible – to some degree – for the medical treatment and results thereof associated with his/her UR determination. In fact, the first court ruling… [Read full story]